The RN Coordinator is accountable for coordinating and overseeing the organization of the MDS process for assigned residents.
• Reviews the list of projected admissions, readmissions and returns from bed-hold. Verifies Managed Care covered residents with Admissions and Managed Care Nurse. Reviews all Admissions using the Medicare Screening Guide to determine coverage. Prepares the Medicare Determination Form for covered residents. Prepares the Physician’s certification form.
• Enters the information of Medicare covered residents into the Scheduler. Email the Medicare Determination (Refer to distribution list under “Medicare covered” and Non Medicare covered”)
• Email the Medicare Determination Form specifying the reason for coverage, number of days covered and the MDS/ Care Planning Meeting Schedule to Nurse Managers a day or 2 after admission. Informs the Nurse Managers or other disciplines concerns needed for completion of MDS booklets.
• When indicated, prepares the Medicare Denial Letters and notify by phone the family or contact persons as soon as determination is done. Issues Continued Stay Denial Letters and Termination Notices when indicated.
• Completes all Scheduled MDS/PPS Assessments on a timely basis.
• Issues Letters of Denial and Termination Notices for residents who no longer meet Medicare criteria for coverage or whose benefits have been exhausted.
• Confers with Patient’s Accounts Department for billing, coding or other concerns as necessary. Reviews all current PPS cases for continued coverage.
• Meets with Rehab to discuss current status of residents receiving Rehab.
• Prepares and participates in weekly CMI and Utilization Review Meeting.
• Other responsibilities as assigned.
Currently licensed as a Registered Nurse in the State of New York.
Minimum one year experience with MDS. RAC-CT preferred.